Amersham Town Council

APPLICATION FORM

NAME :………………………………………………….
POST: Part Time - Groundsman/Gardener
CLOSING DATE: 26 February 2018
Please complete this Application Form. Further sheets may be used as desired.You may attach any other relevant supplementary information to this form, but all sections of the form must be completed as fully as possible. ATC is an Equal Opportunities Employer and all applications will be considered in line with our Equal Opportunities Policy – a copy of which is available on request.
Personal Details
Surname / Other Names / Preferred Title
e.g. Mrs/Ms/Miss/Mr
Home address / Telephone Number
Home:
Business/mobile:
Current Full
Driving Licence
YES/NO / Vehicle Owner
YES/NO / Car Available
for office use
YES/NO / Are you legally entitled to work in the UK?
Yes ……. No………
Unspent Criminal Convictions/Cautions. Declaration subject to the Rehabilitation of Offenders Act 1974. If YES, please give details:
A minimum of TWO references are required of whom
one should be your present employer (or most recent employer if not currently employed). Employment references are required for at least the past three years. / NOTE: References will normally be taken up before interview. Please indicate if you do not want a reference to be taken up at this stage and why. Please indicate if your referees know you by another name.
1) Name
Address
Occupation
Telephone No. / 2) Name
Address
Occupation
Telephone No.
3) Name
Address
Occupation
Telephone No. / 4) Name
Address
Occupation
Telephone No.
Education - You may wish to give details of other Training and Development activities
(e.g. project work, secondments, etc) under supplementary information on page 5.
Please give details of Schools, Colleges, etc attended, excluding primary schools, but including professional/technical training.
Full time education - please show schools attended
from age 11 / Dates
From To / Examinations passed. Please show date of passing and grade
Further/higher education - college, university, correspondence courses etc. / Dates
From To / Examinations passed. Please show date of passing and grade
Short Courses Attended/Other training undertaken
Studies/Training in Progress
Membership of Professional Bodies or Institutions
Date Obtained / Name of Body/Institution / Level of Membership
NOTE: Evidence of Qualifications will be required prior to appointment.
CurrentEmployment (or most recent)
Name and Address of Employer / Date Appointed / Total Remuneration Package (Please
give details of salary/grade and any
other benefits such as car allowance
and performance related pay etc.)
Date of Leaving
(if relevant)
Post Title
Brief outline of main objectives and duties of post
Please describe your position within your present organisation’s structure, indicating to whom you report, and who report to you. You may wish to draw, or attach, an organisation chart
Why are you seeking to change your present post, or why did you leave your previous post?
Period of notice required in present post …………………
Previous Employment / (most recent appointment to be shown first)
Post Title and brief
description of duties / Employers Name and Address - please show most recent first. Please include service with the Armed Forces / Dates
From To / Reason for Leaving
Supplementary Information
Please detail relevant experience to date and any other factors you consider make you a strong candidate for this post.(Further sheets may be used as desired.)
Note: A non-smoking policy applies within AmershamTown Council
Interests outside work
Data Protection
The Data Protection Act 1998 (‘the Act’) sets out certain requirements for the protection of your personal information against unauthorised use or disclosure. The Act also gives you certain rights. Except to the extent we are required or permitted by law, the information which you provide in this application form and any other information obtained or provided during the course of your application (‘the information’) will be used solely for the purpose of assessing your application. If your application is unsuccessful or you choose not to accept any offer of employment we make, the information will not be held for longer than is necessary, after which time it will be destroyed, although relevant information will be retained in the longer term to facilitate your equal opportunity monitoring. If your application is successful, the information will form part of your employment file and we will be entitled to process it for all purposes in connection with your employment. So that we may use the information for the above purposes and on the above terms, we are required under the act to obtain your explicit consent. Accordingly, please sign the consent section below.
I CONSENT TO MY PERSONAL INFORMATION BEING USED FOR THE PURPOSES AND ON THE TERMS SET OUT ABOVE.
Signed: …………………………………………………………….. Date: ……………………………..
HEALTH
Do you require any reasonable adjustments for the interview and selection process? YES / NO
If yes please provided details:
Are you related, or in a relationship, to any Member or Senior Officer of the Council? YES/NO
If YES, give details in a separate letter addressed to the Town Clerk. Failure to do so could result in disqualification or dismissal without notice.
I understand that canvassing of Members of Council or any Committee of the Council, directly or indirectly, for any appointment, would disqualify my application.
The information provided is correct to the best of my knowledge.
Signed …………………………………….. Date ………………………
Please state where you saw the vacancy advertised. In case of queries, please email